title: Nurse-led school-based clinics for skin infections and rheumatic fever prevention: results from a pilot study in South Auckland.
abstract: OBJECTIVE
  To assess the acceptability and feasibility of delivering targeted primary health care in a decile one primary school setting.
  
  
  METHODS
  A pilot public health nurse (PHN)-led clinic was set up in a South Auckland primary school (roll approximately 400). The clinic was based on a previous sore throat clinic model with modifications aimed at improving programme feasibility and effectiveness. The timely identification and treatment of Group A Streptococcal (GAS) throat infections to prevent rheumatic fever (RF), and the prevention and treatment of four skin infections (cellulitis, impetigo, infected eczema and scabies) were the focus. The pilot ran for 15 weeks from April to July 2011. Evaluation included documentation review, key school and healthcare stakeholder interviews and parent questionnaires.
  
  
  RESULTS
  The consent rate was 92.2%. Of a total 722 throat swabs taken from 337 students, 94 were GAS positive. Ninety-eight assessments of skin conditions were completed at which 76 had a skin infection diagnosed, the most common infection being impetigo (n=46). Thirty-one skin infections were diagnosed in the first week of the pilot. PHN workload was high with a total of 539 phone calls, 137 home visits and 51 school-based parent consultations. The approach was highly acceptable to the majority of key stakeholders. Extrapolating pilot costs results in an estimated annual cost of $510 per student for the programme.
  
  
  CONCLUSIONS
  It is likely to be both acceptable and feasible to take this model of delivering targeted primary health care to school aged children and use it on a larger scale. The complexity of providing this type of service should not be underestimated and it is essential that robust processes are in place to ensure smooth, safe running of such a programme. Long-term outcome evaluation will be vital to assess programme effectiveness.
authors.affiliation: Counties Manukau District Health Board, Auckland, New Zealand.
authors.forename: Sarah
authors.initials: S
authors.lastname: Gray
authors.forename: Diana
authors.initials: D
authors.lastname: Lennon
authors.forename: Philippa
authors.initials: P
authors.lastname: Anderson
authors.forename: Joanna
authors.initials: J
authors.lastname: Stewart
authors.forename: Elizabeth
authors.initials: E
authors.lastname: Farrell
mesh_terms: D000900:Anti-Bacterial Agents / Q000627:therapeutic use*; D002481:Cellulitis / Q000188:drug therapy / Q000517:prevention & control; D002648:Child; D002675:Child, Preschool; D005240:Feasibility Studies; D006801:Humans; D007169:Impetigo / Q000188:drug therapy / Q000517:prevention & control; D007306:Insecticides / Q000627:therapeutic use; D009520:New Zealand; D010342:Patient Acceptance of Health Care; D026023:Permethrin / Q000627:therapeutic use; D010612:Pharyngitis / Q000175:diagnosis / Q000188:drug therapy* / Q000209:etiology; D010865:Pilot Projects; D057184:Practice Patterns, Nurses'; D015397:Program Evaluation; D011637:Public Health Nursing / Q000379:methods*; D012213:Rheumatic Fever / Q000517:prevention & control*; D012532:Scabies / Q000188:drug therapy / Q000517:prevention & control; D012572:School Health Services; D012874:Skin Diseases, Infectious / Q000188:drug therapy* / Q000517:prevention & control; D013290:Streptococcal Infections / Q000150:complications / Q000175:diagnosis / Q000188:drug therapy*
chemical_list: D000900:Anti-Bacterial Agents; D007306:Insecticides; D026023:Permethrin